Idiopathic Parkinson’s disease and chronic pain in the era of deep brain stimulation: a systematic review and meta-analysis

Oliver FloutyDepartment of Neurosurgery, University of South Florida, Tampa, Florida;

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Kazuaki YamamotoDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

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Jurgen GermannDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

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Irene E. HarmsenDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

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Hyun Ho JungDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea;

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Cletus CheyuoDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

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Ajmal ZemmarDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;
Department of Neurosurgery, University of Louisville, School of Medicine, Louisville, Kentucky; and
Department of Neurosurgery, Henan Provincial People’s Hospital, Henan University People’s Hospital, Henan University School of Medicine, Zhengzhou, China

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Vanessa MilanoDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

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Can SaricaDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

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Andres M. LozanoDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;

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OBJECTIVE

Pain is the most common nonmotor symptom of Parkinson’s disease (PD) and is often undertreated. Deep brain stimulation (DBS) effectively mitigates the motor symptoms of this multisystem neurodegenerative disease; however, its therapeutic effect on nonmotor symptoms, especially pain, remains inconclusive. While there is a critical need to help this large PD patient population, guidelines for managing this significant disease burden are absent. Herein, the authors systematically reviewed the literature and conducted a meta-analysis to study the influence of traditional (subthalamic nucleus [STN] and globus pallidus internus [GPi]) DBS on chronic pain in patients with PD.

METHODS

The authors performed a systematic review of the literature and a meta-analysis following PRISMA guidelines. Risk of bias was assessed using the levels of evidence established by the Oxford Centre for Evidence-Based Medicine. Inclusion criteria were articles written in English, published in a peer-reviewed scholarly journal, and about studies conducting an intervention for PD-related pain in no fewer than 5 subjects.

RESULTS

Twenty-six studies were identified and included in this meta-analysis. Significant interstudy heterogeneity was detected (Cochran’s Q test p < 0.05), supporting the use of the random-effects model. The random-effects model estimated the effect size of DBS for the treatment of idiopathic pain as 1.31 (95% CI 0.84–1.79). The DBS-on intervention improved pain scores by 40% as compared to the control state (preoperative baseline or DBS off).

CONCLUSIONS

The results indicated that traditional STN and GPi DBS can have a favorable impact on pain control and improve pain scores by 40% from baseline in PD patients experiencing chronic pain. Further trials are needed to identify the subtype of PD patients whose pain benefits from DBS and to identify the mechanisms by which DBS improves pain in PD patients.

ABBREVIATIONS

DBS = deep brain stimulation; GPi = globus pallidus internus; KPPS = King’s Parkinson’s Disease Pain Scale; MeSH = medical subject headings; NRS = numeric rating scale; PD = Parkinson’s disease; RCT = randomized controlled trial; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale; VAS = visual analog scale.

Supplementary Materials

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Figure from Kim et al. (pp 1601–1609).

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